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06-02—'16 15:14 FROM— FIRESIDE T—�69 P�4�3i�444 F-554
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<br /> d 'i'es,th'ss section applies ;
<br /> The r�pl�cement of a�esidential fixture or appliance that me�ts all threz of the following requirements: �
<br /> 1. boes noe rtc�uire madifcation to alecirioal or gas sarvice. �
<br /> 2. C-�as a tatal cosc of$500.00 or tess;excludin the cost of the fixture or appliance:and
<br /> 3. Is improved,installed or replaced b�the homeowner or licensed eontractor. �
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<br /> Skip next section,if ehis applies; Cost af Permit $ 15.00 "•
<br /> State Surcharge $ 5.00
<br /> Mail-In�'ee(If Applicable) $ 2.00
<br /> Tbtgl Permit Fee S
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<br /> � Ifabove does not appl�+;fallow guidalines belaw: t
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<br /> 1. CONTC2AC'C P�C� *is 1.25%of contruct price with s(Minilnum Fee of$50.00)
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<br /> Conts�ct pribe) � (roi'nlpium 550.00
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<br /> 2. STATE SURCHARGE 2 �7� OUOSY$ . � /
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<br /> 3. pOSTAGE&HANDLCNG(Only on Mail-Tn Applications) � �2.40�.�� � �) �
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<br /> 4. TOTAC.p�RMYT�'E�(Add T.ines 1-3 Above) �$ �.: ����.�•:••'--.��.� .....} `
<br /> ■ * CONT1tACT E'1tIC�or J0� COST maans the actu�l or estimated dollar amount charged for tho �
<br /> permitted work including materisls,tabor,profit,and other fixed costs. [e is tihe a,nount to be charged
<br /> to the oustomer for the work done. Tf any material,aquipmant,labar or installations are furn;shed by
<br /> the owner,tenant or any other parly,the reasonable market value of suoh items must be added to the
<br /> estimated co�st or contract price for germit fee purpases. Cn the event that th�re is a dispute an the
<br /> amount of the job eost,the City may r�qu�st the submission of a signed cop�r of the actual contract. �
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit>agrees to do all
<br /> work in stricC accordance with the ordinances of the City and the regulations of the State of
<br /> Minnesota, and certifies 4hat all statements made on ' application are complete, true and
<br /> GOrrBCt.
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<br /> Applicant's Signature- . �I�ate:3 � ��'���
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